Time to non-retention in HIV care and associated factors among assisted partner notification HIV+ patients enrolled in care in Hoima and Kiboga Districts, Uganda

Abstract

Introduction: Globally, by the end of the year 2020, enormous strides had been made toward the achievement of the UNAIDS 90-90-90 HIV testing and treatment targets that were set in 2014. Such targets had spelled out that by 2020: 90% of the population living with HIV were to know their status, 90% of those diagnosed HIV positive were to be started and sustained on antiretroviral therapy (ART) and 90% of those on ART were to achieve sustained viral load suppression. Since 2014, several innovations were implemented to accelerate the achievement of these targets among which, included the assisted partner notification (APN) to tap into the sexual networks of all identified HIV-positive clients. Whereas APN contributed towards accelerating the attainment of the first “90”, limited documentation exists in regard to how well patients identified through APN are retained in HIV care. This study, therefore, sought to establish the magnitude of non-retention, time to non-retention, and factors associated with non-retention of patients identified under APN. Methods: Sexual partners elicited by index clients that tested HIV positive and were enrolled into HIV care in health facilities of Kiboga and Hoima districts from 1st Jan 2017 to 31st Dec 2019 were retrospectively followed up. HIV care data of the identified sexual partners were collected to determine the time-to-non-retention and associated factors. The study determined the proportion of non-retention and time-to-non-retention for patients initiated under the APN program and associated factors using survival analysis methods. Time-to-non-retention is presented using the Kaplan-Meier curves. Cox proportional hazards regression was used to estimate adjusted hazard ratios of factors associated with non-retention using STATA version 14. Results: Of the 354 clients included in the study, 51.4% were females, 71.2% were married, and 43.0 % had attained at least primary-level education. Overall, non-retention was 15.8 % at 12 months post enrolment into HIV care and the average time to non-retention was 264days (±101days). Non-retention did not differ significantly between males (15.7%) and females (15.9%,) p=0.84. In the multivariable model, access to a phone (aHR=0.56, 95% CI, 0.16-2.10, p=0.003), age >25years (aHR=0.31, 95% CI 0.1-0.91, p=0.034 as well as enrolment at a higher-level facility (regional referral) were associated with lower risk of non-retention while being enrolled in care when a patient is in WHO stage IV compared to WHO stage I (aHR=22.7, 95% CI, 2.59-189) was associated to a higher risk of non-retention

Conclusion The 12-month cumulative non-retention among clients enrolled under the APN strategy was high. Access to a phone, enrollment in a higher-level health facility as well as being enrolled in WHO clinical stage 1 and 2 was associated with a lower risk of non-retention. Therefore, it is paramount for health workers enrolling clients into care to encourage clients to provide their phone contacts or alternative numbers to facilitate follow-up as well as encourage early identification and enrollment in care before disease progression as this has proven to be associated with a lower risk of non-retention.